Provider Demographics
NPI:1417291865
Name:KEHLA, ZACHARY KONGNSO
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:KONGNSO
Last Name:KEHLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 PEARL DR APT 202
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2140
Mailing Address - Country:US
Mailing Address - Phone:240-938-2281
Mailing Address - Fax:
Practice Address - Street 1:3506 PEARL DR APT 202
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2140
Practice Address - Country:US
Practice Address - Phone:240-938-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide